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South Dakota rates for HCPCS 21400

Clsd Tx Fx Orbit Except Blowout W/O Manipulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$172.33 / $222.83 / $222.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.94 / $177.47 / $339.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.82 / $501.55 / $643.73
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$233.77 / $295.57 / $497.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.59 / $456.11 / $1,625.12
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$362.27 / $456.11 / $658.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.66 / $382.66 / $520.98
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.77 / $322.66 / $432.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.71 / $363.74 / $565.82
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.60 / $413.00 / $525.29